Monday, April 15, 2013

Population Health or Bust!

My April editorial post for Clinical Innovation + Technology is called "Population Health or Bust!".   The premise is that we know reimbursement models are changing from "Volume-Based to "Value-Based care", which may range from gain-sharing to bundled payments to full capitation... And thus we need certain types of tools to better manage our populations of patients.  So I defined what these population management tools should do and what to consider when purchasing them:

First, population health management means that you (1) define a specific population and (2) manage that population in the most efficient, cost-effective and highest quality manner possible.  In other words, instead of treating everyone the same, you provide the right care to the right people in the right time and in the right format. This helps to ensure that we focus our limited resources on the people who need them most, while using innovative strategies and technologies to leverage care for others.
Second, be on the lookout for some key functionalities when choosing your population management tools. These include risk stratification, impactability analysis, care gap identification, outreach capabilities, care coordination dashboard, patient engagement systems and analytics reporting.
Third, population health tools are everywhere right now, including offerings from your EHR vendor, your insurance companies and various third parties. Factors to help guide your decision will include not just the strength of their offering, but their ability to integrate into your workflow, their ability to work with multiple data sources, and their future visions. Additionally, we are starting to see interesting gain-sharing business models that may make initial investments free or cheap.
I ended my post explaining why I believe that when dividing populations into "Low, Medium, and High" risk, that the really cool innovations (e.g. mobile monitoring, telehealth, automated care) will be in the Low and Medium categories, rather than the High risk ones.  And furthermore, that this will hopefully open up more free time for physicians to spend with the "High risk" patients who needs more of the face to face care we consider traditional right now.  Said another way... let's automate the easier stuff so we can allow for more time, critical thinking and compassion for the tougher stuff! 
Companies in the Population Health Space (at least a partial list)
·         Advisory Board Company:
·         CareMerge (focus on elderly):
·         Care Team Connect:
·         Clairvia http:
·         Click4Care:
·         Clinigence:
·         Curaspan (SAAS – Handoffs):
·         Essence HC:
·         EvolentHealth (UPMC + ABC):
·         GSI Health (Lori Evans) (CC Platform):
·         Healarium (Mobile Pt Activation Apps):
·         Humedica (bought by Optum 1/13):
·         Intelligent Healthcare:
·         Lumeris (ACO for hospitals):
·         Medventive (bought by HBOC 2012):
·         Outcome Advantage:
·         Patient Point:
·         Pharos (Dz mgt, Randy Williams):
·         Phytel:
·         RipRoad:
·         See Change (Insurance and Systems for Employers):
·         Symphony (ACO Software):
·         TCS:
·         US Health Centric (Dx/Wellness mgt):
·         Valence Health:
·         Vital Health:
· (Checklist based Workflows for Discharges):
·         Wellcentive:
·         xG Health Solutions (Geisinger Spin-off): 

I will edit this list over time - but it gives one a sense of how many companies are already in the space in one form or another (and this does not even include all the EMR vendors and their offerings).

Wednesday, April 03, 2013

HIMSS 2013 Review

Some thoughts on the HIMSS 2013 Conference in New Orleans (March 3-7)

Pre-Conference Advice
I wrote a short column on "Innovators at HIMSS" - my advice on how to Find, Share or Sell Innovation - by breaking down the conference into three chunks:  Educational Sessions, the Exhibit Hall and Networking.

Overall Impression of the Conference
I still love New Orleans as a city and as a convention spot (not an opinion shared by everyone)!  Of course I did have a hotel within walking distance.  I also liked that the "exhibit floor" was constrained and thus the vendors had smaller booths… but it seemed they all had plenty of room.  With that said, I felt more rushed than ever trying to see everything on the vendor floor, and for the first year ever, I didn't even have time to attend many of the educational sessions.  Is HIMSS becoming more vendor fair than educational?  Not necessarily, when you have 35,000 people - there are different needs and I still think the educational sessions are important for different people in different roles in different stages.  But this year, my role was more about exploring - especially in the population health arena, of which EVERYONE seemed to have an answer.

Personal Highlight
Getting to meet and talk with Dr. Larry Weed, who gave a brilliant closing keynote at the Physician Symposium on Sunday... he is a hero and legend to many of us in the healthcare informatics field.  He developed the concept of organizing the medical record in the SOAP format, created one of the first computerized medical record systems, and has been a long-time voice in helping doctors learn how to "think better" in taking care of our patients.  I plan to write an expanded blog on his talk in the near future, but here is what I've said in the past.

Hot Topics
I think there were two clear camps:  (1) Meaningful Use: finishing up stage 1, getting ready for stage 2; and (2) Population Health tools: understanding who were the players, what do they do, what are the business models, etc.

Population Health Companies
Here are some I saw and/or I think have good relevance in this space (and it is far from complete):

Some Assorted Cool Things I Saw
HealthCatalyst:  An analytics company with a really good story of what they do… They start with an analysis of high cost and high volume activities which also have a high variance in your health system.  After mutually agreeing on where to focus and how much money might be saved by reducing variance closer to the mean scores, they help you determine why the variance is high (via more in-depth analytics) so you can correct it.  Concept is simple, but the execution is the critical part and they seem to have captured some secret sauce that makes them very good at this.  And they've got some great people, including all start CIO Dale Sanders.  An interesting "telemedicine in a box" concept... where they will build a self-contained telemedicine "box" wherever you want it (e.g. a pharmacy, a company's warehouse, an underserved youth center, etc.).  A patient goes in the box, fills out some computerized forms, and they then have a live video feed with a doctor.  But the key is that they also have access to a variety of "tools" which they can use on themselves to show the doctor everything they need to see - including a stethoscope, and devices to look at eyes, ears and skin at visual magnifications greater than one could even get in the office!  A medical assistant staff person can help if there is confusion.  The MA also does basic clean-up, and there is some automated UV-light cleansing as well.  Is this better than Skype and buying the tools separately... not sure, but it's something to consider. 
ReadyDock:  A simple little "iPad Dishwasher" which stores, charges and sterilizes handheld computers, such as the iPad.  I think we will be seeing more iPad use in hospitals, by both providers and patients… so this could be a really good idea.  I do wonder if just having a plastic "cleanable" cover over these iPads might be a simpler, cheaper idea... this is something that has to be tested out.